Abstract
Drs Gilder and Brown correctly point out that the dose escalation described in my case report is contrary to the manufacturer's guidelines. However, the reason for using the dose escalation regime described is that this has been our normal clinical practice over the last 5 years of use of lamotrigine in many hundreds of patients. Furthermore, we have published a blinded, randomized controlled trial using the dose escalation suggested by Glaxo-Wellcome and found no analgesic effect when lamotrigine was used in a dose increased to 200 mg daily. 1 McCleane GJ 200 mg Lamotrigine has no analgesic effect in neuropathic pain: A randomized, double-blind placebo-controlled trial. Pain. 1999; 83: 105-107 Abstract Full Text Full Text PDF PubMed Scopus (133) Google Scholar This is very much at odds with our clinical experience with the drug. A possible reason for this conflict is the differing dose escalation regime. When a drug produces the desired effect in clinical practice when used in a particular fashion, it is hard to change its use to a method that is proven not to be effective.
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